A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer.
Abdominoperineal resection
Perineal wound healing
Rectal cancer
Wound closure
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
11
09
2020
accepted:
10
05
2021
pubmed:
16
7
2021
medline:
22
9
2021
entrez:
15
7
2021
Statut:
ppublish
Résumé
The aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer. Patients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016-2021) were compared to a multicentre cohort of primary closure (2000-2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis. Twenty-five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734-6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184). The uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer.
METHODS
METHODS
Patients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016-2021) were compared to a multicentre cohort of primary closure (2000-2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis.
RESULTS
RESULTS
Twenty-five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734-6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184).
CONCLUSIONS
CONCLUSIONS
The uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.
Identifiants
pubmed: 34263363
doi: 10.1007/s10151-021-02496-7
pii: 10.1007/s10151-021-02496-7
pmc: PMC8419133
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1123-1132Informations de copyright
© 2021. The Author(s).
Références
Dis Colon Rectum. 2019 Aug;62(8):952-959
pubmed: 30747743
Tech Coloproctol. 2019 Aug;23(8):751-759
pubmed: 31432332
Colorectal Dis. 2019 Sep;21(9):1094-1095
pubmed: 31116492
Plast Reconstr Surg. 2016 May;137(5):1602-1613
pubmed: 26796372
Dis Colon Rectum. 2008 Aug;51(8):1237-41
pubmed: 18481146
Dis Colon Rectum. 2014 Sep;57(9):1129-39
pubmed: 25101610
BMC Surg. 2020 Jul 23;20(1):164
pubmed: 32703182
Colorectal Dis. 2009 Oct;11(8):806-16
pubmed: 19055518
Int J Colorectal Dis. 2019 Nov;34(11):1963-1970
pubmed: 31686200
J Gastrointest Surg. 2009 Apr;13(4):657-67
pubmed: 19082672
Medicine (Baltimore). 2018 May;97(18):e0653
pubmed: 29718883
Ann Surg. 2022 Jan 1;275(1):e37-e44
pubmed: 33534231
Ann Surg. 2017 Jun;265(6):1074-1081
pubmed: 27768621